Provider Demographics
NPI:1336029628
Name:FODY LANDSTROM, BRIGITA MARGARET
Entity type:Individual
Prefix:
First Name:BRIGITA
Middle Name:MARGARET
Last Name:FODY LANDSTROM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:757 MALETA LN STE 101
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-7612
Mailing Address - Country:US
Mailing Address - Phone:720-733-8886
Mailing Address - Fax:
Practice Address - Street 1:757 MALETA LN STE 101
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80108-7612
Practice Address - Country:US
Practice Address - Phone:720-733-8886
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-05
Last Update Date:2025-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACC.0021362101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)